Form A: Annual Review Form – 1
DEP ARTM ENT OF APPLI ED PSYCHOLOG Y
Doctoral Program in Counseling Psychology
UPDATED
4/1/12
Annual Review
Academic Year __________
Name of Student: ______________________________________
Address: _____________________________________________
Phone #: _________________________ E-mail: ______________________
Name of Advisor: _____________________________________
Year of original matriculation: _______ Master’s Degree Prior to NYU Yes___ No___
Credits Completed
Credits to be completed during the current academic year ___________
Total number of credits to be completed at the end of the current academic year _____________
Total number of credits left to complete at the end of the current academic year ______________
Work and Student Status during Current Academic Year
Work Status (Check One)
Full-time
Part-time
Student Status (Check One)
Full-time
Part-time
Full-time work = 25 or more hours per week
Full-time student = 12 or more credits or equivalent per semester
Program Comprehensive Exam
Status of Comprehensives (Check the appropriate ones)
Data Based Research Paper
Case Study Paper
Not yet started
Not yet started
In preparation
In preparation
Completed
Completed
Comprehensives results
Comprehensive exam: Written date: ___________
Comprehensive exam: Orals date: ___________
Comprehensives papers titles:
1.__________________________________________________________________
2.______________________________________________________________________
Comprehensive Exam Results:
________________________ date: __________
________________________ date: __________
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212 998 5555 | 212 995 4358 fax | applied.psychology@nyu.edu | www.steinhardt.nyu.edu/appsych
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Form A: Annual Review Form – 2
Externship/Practicum Experiences
Semester/Year: ____ Site: _______________________
Type of Setting: ___________________________
Name of Primary supervisor: _______________________Degree_____
Licensed: Yes___ No__
Hrs per week:_______ Total Hours: _______
Semester/Year: ____ Site: _______________________
Type of Setting: ___________________________
Name of Primary supervisor: _______________________ Degree_____
Licensed: Yes___ No__
Hrs per week:_______ Total Hours: _______
Research Experience
Semester/Year: ____ Site: _______________________
Type of Setting: ___________________________
Name of Mentor: _______________________
Hrs per week:_______ Total Hours: _______
Semester/Year: ____ Site: _______________________
Type of Setting: ___________________________
Name of Mentor: _______________________
Hrs per week:_______ Total Hours: _______
Publications & Presentations:
Teaching Experiences
Training in Teaching:
Course Taught:______________________Semester/Year: ____ School, Department:_________
Name of Mentor: _______________________
Course Taught:______________________Semester/Year: ____ School, Department:_________
Name of Mentor: _______________________
Teaching Evaluations:
Dates of Counseling Forums attended:
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Form A: Annual Review Form – 3
Internship
Preparation for internship
In what year do you plan to do your internship? ______________________________
Is there a current (this academic year) update of your internship portfolio in your file?
(Check one)
Yes
No
If you have completed or are currently on internship, please complete the following questions
about internship.
Internship year :
Internship setting/institution :
APA status of internship :
Funding status of internship (Check one) :
Full
Partial
None
Dissertation
Dissertation Proposal Seminar (Check one)
Not yet taken
One semester taken or in progress
Dissertation chair (Check one)
Yes (Name of Chair: ____________________________)
No
Full Dissertation committee appointed and filed with graduate office (Check one)
Yes (Date: ____________________)
No
Names of committee members: ____________________________________________________
Dissertation proposal approved
Yes (Date: ____________________________________) No
Title of Dissertation: ____________________________________________________________
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Form A: Annual Review Form – 4
PROFESSIONAL DEVELOPMENT (For the 2011-2012 academic year ONLY)
1. I was a member of a professional or research society:
Yes
No
(Please list): _____________________________________________________________
2. I was involved in grant-supported research:
Yes
No
3. I was involved Part-time in Supervised Practicum Training on or off
campus:
Yes
No
4. I was involved in leadership roles/activities in professional organizations:
(including roles in State/Provincial, Regional, or National
organizations)
Yes
No
5. I presented psychological topic to lay or community audience
Yes
No
6. Number of books, book chapters, or articles in peer reviewed
professional/scientific journals in which I was an author or
co-author: (Publications “in press,” “under review,” or “submitted”
should not be counted here)
____________
(Please list all publications submitted, accepted, or published since 9/1/11):
Publications: Submitted _____ Accepted_______ Co-author__________________________
Title: ______________________________________________________________________
Journal or book title __________________________________________________________
Publications: Submitted _____ Accepted_______ Co-author__________________________
Title: ______________________________________________________________________
Journal or book title __________________________________________________________
Publications: Submitted _____ Accepted_______ Co-author___________________________
Title: ______________________________________________________________________
Journal or book title __________________________________________________________
7. Number of workshops, oral presentations, and/or poster presentations
at professional meetings in which I was an author or co-author:
__________
Conference Presentations: Date: ______ Name of Conf._____________________________
Title: _________________________________ Type of Presentation: _________________
Conference Presentations: Date: ______ Name of Conf._____________________________
Title: _________________________________ Type of Presentation: __________________
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Form A: Annual Review Form – 5
PROFESSIONAL DEVELOPMENT (For the 2011-2012 academic year ONLY) (Continued)
8. Teaching Experiences: Course Title________________________________________
Supervisor ____________________________ MA level _____ Undergrad_______
9. Research Assistantships: Hours per week_____ Supervisor: ______________________
Activity and topic: ______________________________________________________
10. Other (Fellowships, Awards): _________________________
Have you maintained the schedule of courses and the other requirements on schedule,
as listed in the Advisement Record, up to and including this semester? ________
If Not, which courses or requirements are outstanding? _______________________
_______________________
_______________________
(These must be included in the Benchmarks below.)
Do you have any Incomplete Grades? _____________
If Yes, which courses have Incomplete grades? _______________________
_______________________
_______________________
(These must be included in the Benchmarks below.)
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Form A: Annual Review Form – 6
Date of Annual Review meeting with advisor: _______
Signature of advisor: ____________________
Signature of student: ____________________
To be completed after annual review by faculty
Annual review outcome:
Satisfactory
Unsatisfactory
Students receiving two consecutive unsatisfactory ratings will be terminated from the
program.
Benchmarks for Next Year
NOTE: Benchmarks must be established at each Annual Review and at the initial
Advisement following admission to the program. (Add pages if necessary.)
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Form A: Annual Review Form – 7
Standard Benchmarks for Maintaining Satisfactory Progress
In the Counseling Psychology Ph.D. Program
1.
2.
3.
4.
5.
Comprehensives should be passed within three years of matriculation.
Within four years of matriculation, a student should have a dissertation committee and an
approved dissertation proposal.
Within four years of matriculation, a student should have been accepted for an internship.
Within five years of matriculation, a student should have completed an internship.
Within five years of matriculation, a student should have passed the dissertation defense.
The preferred yearly program outline is as follows:
Year 1: Course work, Research, Application for external funding
(Very motivated students may also consider:
Conference presentation submission and / or Publication submission)
Year 2: Course work, Research, Externship, Application for external funding,
Conference presentation submission, Publication submission
Year 3: Course work, Research, Externship, Comprehensive Exams, Teaching,
Application for external funding, Conference presentation submission,
Publication submission
Year 4: Course work, Dissertation Proposal, Research, Externship,
Internship Application, Application for external funding,
Conference presentation submission, Publication submission
Year 5: Full Time Internship, Dissertation, Application for external funding
Note: These benchmarks can be extended with the approval of the advisor based on
extenuating circumstances or specific factors that may delay completion of the internship or
the dissertation, so long as there is a concrete target date for completion within eight years of
matriculation.
Note:
Students should fill in as many items as they can on a provisional electronic copy of the Annual
Review Form. Students need to detail goals achieved in all areas (teaching, research, etc.) and a
listing of all of next year's goals / benchmarks for each area, and email this semi-completed form
to their advisor as soon as possible. Students are responsible to ask each of their supervisors and
mentors for to give them evaluation and benchmark / goal notes (or to send them to the advisor)
before the annual review meeting on the scheduled review date. Students must contact their
advisors and schedule a REQUIRED meeting BEFORE the Annual Review date to discuss (and /
or modify) the review and benchmarks. Be sure to bring a hard copy of your provisional Annual
Review Form to the meeting. In addition, an electronic copy of the Annual Review Form must be
sent to the Program Director for accreditation documentation.
The Annual Review Form is in the Handbook. It can also be downloaded from the following link:
http://steinhardt.nyu.edu/scmsAdmin/media/users/bjv211/Annual_Review_Form_from_Handbook.doc
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